Table Of ContentThese things that live on departure understand when you praise them: fleeting,
they look for rescue through something in us, the most fleeting of all. Will us to
change them entirely, within our invisible hears, into – oh endlessly – into
ourselves! Whosoever we are. - Rilke, Duino Elegies
We shall not cease from exploration
And the end of all our exploring
Will be to arrive where we started
And know the place for the first time
T.S. Eliot, Little Gidding
. . . to be present with the sick or maimed is to find and feel oneself called on. Just
here, one sees the real significance of plain talk, a simple touch, the direct look
and the sick person’s need to hear that world, feel that touch, note that look. That
simple human touch, the sound of the human voice, the notice in the human look
appear as touchstones of the moral order and enable the person to know in the
most immediate way that he or she is recognized and affirmed. This act of
affirming of one another, of being with one another in our mutual relatedness, is
the hearthstone of our common humanity.
Zaner, 1993, Troubled Voices, pp. 145-146
University of Alberta
In the Queue for Bariatric Surgery: A Phenomenology of Waiting
by
Nicole M. Glenn
A thesis submitted to the Faculty of Graduate Studies and Research
in partial fulfillment of the requirements for the degree of
Doctor of Philosophy
Faculty of Physical Education and Recreation
©Nicole M. Glenn
Spring 2014
Edmonton, Alberta
Permission is hereby granted to the University of Alberta Libraries to reproduce
single copies of this thesis and to lend or sell such copies for private, scholarly or
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users of the thesis of these terms.
The author reserves all other publication and other rights in association with the
copyright in the thesis and, except as herein before provided, neither the thesis nor
any substantial portion thereof may be printed or otherwise reproduced in any
material form whatsoever without the author's prior written permission.
Dedication
To my family who helped me to get here and Julian who helped me get through.
Abstract
Purpose: To explore the lived-experiences of waiting to have bariatric surgery.
Research Question: What is it to wait for bariatric surgery?
Methods & Participants: I responded to this question using a human science
approach to phenomenology of practice. I conducted multiple, in-depth,
phenomenological interviews with seven participants recruited from a publically
funded bariatric clinic in Western Canada. Experiential sources (i.e., interview
transcriptions, written experiential descriptions) were analyzed guided by the
phenomenological reflection, reduction and writing practices.
Texts (‘Findings’): This inquiry resulted in three manuscripts through which I
explored different meaning-aspects of the phenomenon of waiting to have weight
loss surgery. The first text, Making Contact: Experiences From the Weight Loss
Surgery Clinic, focused on experiences of contact within the pre-bariatric surgical
period. I questioned the ethical significance of relational encounters that occurred
within the wait drawing on the writings of philosophers Alphonso Lingis and
Emmanuel Levinas. The second text, Phenomenological Insights on Mandatory
Weight Loss and the Wait to Have Bariatric Surgery, explored experiences of a
pre-surgical requirement that weight loss be achieved prior to surgical approval. I
questioned the ethical and practical significance of the practice. In the final text,
Phenomenological Insights and Metaphor: Building a House As the Wait to Have
Bariatric Surgery, I considered the experience of waiting to have bariatric surgery
through the metaphor of house building drawing on insights cultivated through
philosophical writings on house, home and building to understand the possible
meaning of the experience.
Concluding Comments & Significance: The findings from these three studies
share a common thread of considering the experience of waiting within the
context of weight loss surgery. Through these texts I explored possible
experiential realities from an ethical perspective often pushing the reader to
question – what is good versus what is right (for the individual receiving care)?
As such, the texts are of particular relevance to clinicians working in bariatric
medicine. The studies also address a significant gap in the bariatric surgical
literature, as there is little qualitative research in the field and particularly with
regards to patient experiences of the pre-surgical period.
Preface: The Pretext – Before Beginning: Reflections on Self, Language &
1
Meaning
I feel conspicuous and uncomfortable as I shuffle around in this extra
wide, blue vinyl chair. I put my bag next to me then under the chair only to
realize that now it is too far for me to grab my things. Are people staring
at me? I imagine they are as I drag my bag back onto the seat again. I
don’t look up. Trying to be as quiet as possible I pull out my notebook and
pen – very discrete indeed. Now people must really wonder what I am up
to here. I feel like an intruder. What am I doing here? I look around. No
one seems to be paying me any attention yet I feel watched. It is I,
however, who is here to watch. I don’t really like watching, not here, and
yet I do ordinarily – I like nothing more than setting myself up at an
outdoor café while the world passes by. This is different. This is not a café,
not even close. This is the waiting room at the bariatric clinic. This is the
place, the space I am supposed to observe. Yet I cannot bring myself to
open my notebook to write anything down. Why such discomfort? This
waiting room is public, anyone can enter; a password or code is not
needed here. And I am not unfamiliar with waiting in medical clinics and
have not been uncomfortable with them in the past, even if waiting for
someone else, or for news that I anticipate I don’t want to hear.
Nevertheless, this feels different. ‘Maybe,’ I think, ‘I am different.’
As I sit in the corner of the waiting room at the weight loss surgery clinic I
contemplate myself in the space. I become increasingly conscious of my body as I
try to shrink away, to go unnoticed. This is not about me, I think. I am here to
watch, to ‘immerse,’ to begin, to study and to inquire – yet none of those words
seem quite right. None capture what I am doing. They describe it as it is
frequently described in qualitative methodological texts (Patton, 2002), sure, but
these words do not feel like what I am doing. What am I doing here?
1
A version of this chapter is being prepared for publication.
I want to know, to understand, to listen and to watch – but for what
purpose? I have come here for a reason; I was drawn here, moved to questioning
through the story of (an)other. This story, however, although compelling, is not
my own. Yet this work is, or at least now I am part of it, the question and the texts
that will follow. I will be in those too, as I am in this waiting room – both in and
out somehow. I ask myself how to proceed and why, what might be the
unintended consequences of the questions I ask, and whose agenda might they
serve? Who might be silenced through the words that I write?
Phenomenology aims to show, to return, to evoke and to let shine forth
what is, as it is, in the everyday world in which we live (van Manen, 1990). It is
an ethical endeavour, a thoughtful way of being, a reflective, embodied,
embedded practice that requires sensitive attunement and attentiveness. It requires
a letting go, a releasing or conscious sitting with and setting aside of pre-
conceived notions, assumptions and judgements. Then why do I feel such
discomfort? Perhaps it will be helpful to consider how I got here and explore what
I thought I knew about people who wait and myself in relation. Here I look to
language as a means of understanding, explicating and exploring these very
questions because, as Lingis (2012) writes,
With words we communicate with others, focusing their attention,
directing them, challenging, defying, warning, threatening, prohibiting.
There are words too that are not addressed to anyone, the words of one’s
unvoiced inner commentary that accompanies what we do and continues
when we are doing nothing, contemplating, dwelling with things. Words
are not only units of a code, designating concepts; they have pitch, attack,
timbre, volume, and duration. They are ponderous, conveying the weight
of things, heavy, weighing down things, or light, lightening, trivializing.
(p. 42)
Language is absolutely inescapable (and vital) within the
phenomenological project, as it is in essentially all human endeavours. Language
impacts lives and lives impact language in turn. What makes me different than
others sitting in the waiting room? Am I really that different? I am not here to
wait, not for surgery at least, that is one thing, but why might be the more
pertinent question. I am not here to wait because I do not require the treatment
2
that is offered here. I am not obese, clinically, morbidly, however one might
categorise. I am not fat, although I, like nearly all women I know, I have felt this
way many times in my life.
I hesitate for a moment before typing the word fat. It feels offensive yet fat
is the word frequently used to describe the bodies (and the people) who wait in
this clinic. Is this the source of my discomfort? This word? There are others too I
am sure. I wonder if that is what is separating us, me and the people who are
waiting, at least separating us in my mind – these words – the bodies and the
3
experiences they entail. I consider the word ‘fat.’
Fat is many things, including a tissue; a signifier and symbol; a self
concept; a set of experiences; and an identity that is constituted in relation
to others, (sub)cultural norms, and systems of power and privilege. Fat is a
curious and contradictory thing, both hypervisible and invisible; both
associated with femininity and desexualized. It simultaneously signifies
both poverty and abundance; public concern and private well being;
inadequacy and excess. . . Fat is often used in the same way as obscenity:
nobody can quite agree on a definition, but we feel we know them when
we see them. (Scott-Dixon, 2008, p. 24)
Fat is more than a tissue that comprises the body – more and at the same time
perhaps less than muscle and bone, flesh and blood. Fat is a signifier and is often
read as such: lazy, stupid, messy, unlovable, unhealthy – unworthy (Lupton, 2013;
2
The term morbidly obese is no longer commonly used and has been replaced in
much of the clinical literature with clinically severe obesity, extreme obesity or
class III obesity. I choose to use it here because it was the term I first encountered
in the clinical literature (it has only very recently changed, see for example
Colquitt, Picot, Loveman, & Clegg, 2009) and has connotations that may connect
it to the experience of the body that undergoes surgical intervention.
3
For an in-depth discussion on the topic and as an entry point into critical fat
scholarship I refer the reader to Lupton’s (2013) recent text, Fat.
Puhl & Heuer, 2012; Scott-Dixon, 2008). We have many words to describe it, and
the people who have (or are) it in excess – corpulent, well-fed, plump, and thick,
big-boned, large, round – just to name a few (Barber, 2004). Some of these terms
are more or less acceptable, feel more or less ‘right’ to the people who live in and
with bodies considered fat. “I’ve always been a big girl,” explains a woman I
spoke to who was pursuing weight loss surgery, “I’ve never been thin,” she
continued. The terminology used and how it is understood may be immensely
personal and enmeshed within the context, the historical moment and cultural
space where it is used (Lupton, 2013; Rothblum & Solovay, 2009). Critical
scholars have re-claimed the word ‘fat,’ preferring it over the medicalized
‘overweight’ or ‘obese,’ which they argue perpetuates the understanding of
fatness as pathological, a diseased, abnormal, deviant state (Lupton, 2013;
Rothblum & Solovay, 2009). I wonder, however, does ‘fat’ show anything of the
experienced body or how it is lived within the world? What about obese, or
morbidly obese? What do these words do and what do they possibly show?
Within the first draft of this thesis, composed more than three years ago, I
used the words ‘obesity,’ ‘overweight,’ and ‘morbidly obese’ throughout the text.
I used these words without consideration or reflection or thought of what they
might mean, of what they might do. I assumed the words were, in the way a table
is a table and a chair is a chair. I was not yet immersed in the phenomenological
mood, the orientation that I have since adopted (or at least attempted to). I was not
yet conscious that words can create but that they can also reduce, qualify, and
section off, they can categorize and remove something (phenomena) from the
world-as-lived. They can be anything but phenomenological.
Ursula LaGuin (1988) writes a powerful narrative about labels (‘names’)
and being, entitled, She Unnames Them. It is an Adam and Eve story of sorts, but
not as one might expect. Eve, who is herself throughout the piece without a name
(perhaps I would have been best to capture the spirit of the text by too leaving her
nameless), unnames the animals in turn. Most accepted namelessness with perfect
indifference, the Yaks, however protested as some felt ‘yak,’ the sound it made as
it slipped off the tongue had a certain fit, but eventually let it go as it was not used
among themselves anyway. LaGuin (1988) writes,
The insects parted with their names in vast clouds and swarms of
ephemeral syllables buzzing and stinging and humming and flitting and
crawling and tunneling away . . . none were left now to unname, and yet
how close I felt to them when I saw one of them swim or fly or trot or
crawl across my way or over my skin, or stalk me in the night, or go along
beside me for a while in the day. (p. 195)
The names that had been given the animals were not theirs and did nothing to
show them as they were in the world, flitting and crawling, scratching, buzzing
and biting. The names did not bring her, ‘Eve’ closer to the animals, if anything
she felt more distance, the names were between them, got in the way of her seeing
them as they were, or knowing them in a way that was meaningful.
I wonder how the labels, obese and morbidly obese, for example, name the
people who enter the weight loss surgery clinic. These labels may name them as
different or sick. How might these names create a barrier between us, prevent me
from seeing them as they are, in the world, uniquely, as I am uniquely in the
world, immensely and impossibly different, yet from each other too and perhaps
not so different at all in the end. How might these names prevent me, and others
from seeing the experience of waiting within the context of weight loss surgery
for what it is, rather than an extension of our accepted understandings of ‘obesity’
as problematic and in need of intervention? Perhaps, waiting to have bariatric
surgery, like most human experiences or phenomena, lies somewhere between or
beyond labels, words and names, just outside the grasp of linguistic possibilities.
Levinas (1972/2006) considers the limits of language,
. . . language refers to the positions of the listener and the speaker, that is,
to the contingency of their story. To seize by inventory all the contexts of
language and all possible positions of interlocutors is a senseless task.
Every verbal signification lies at the confluence of countless semantic
rivers. (p. 6)
